The symptoms can be abject misery: searing abdominal pain, debilitating stomach cramps, an excruciating, rising burn, acid-filled hiccups, tightened throat, constant sleep disturbance, and even the rare but terrifying bouts of choking from nighttime acid inhalation. I’m talking of course about acid reflux or GERD as it’s commonly called these days. I personally suffered from occasional bouts of GERD and experienced all the symptoms above for years during and even after my endurance days. (It wasn’t until I gave up grains that my GERD completely disappeared.) Maybe you’ve had it. Maybe you know someone who’s had it. GERD, by the way, isn’t your run-of-the-mill occasional heartburn (which isn’t much fun either) but a chronic pattern of heartburn in which you experience symptoms at least a few times a week. I get emails about it all the time, and it’s little wonder. Statistics suggest that 25-30% of American adults experience GERD related heartburn multiple times a week (PDF). Of all the pharmaceutical categories, proton pump inhibitors (a predominant prescription for GERD) have ranked consistently in the top twenty for years. And that doesn’t even take into account the old-fashioned antacids like Tums and Rolaids that people pop like candy. What, for the love, is going on here? It used to be heartburn was generally confined to women in their last months of pregnancy or to the annual Thanksgiving overindulgence. It certainly wasn’t a chronic condition plaguing a large percentage of the population. I sense a familiar pattern here, no?

What is GERD anyway? What causes – or at least contributes to it? How do everyday lifestyle choices influence the condition, and what measures – beyond the CW pharmaceutical schtick (e.g. the happy, ubiquitous “purple pill”) – can we employ in treating, let alone curing the condition. (While the establishment might be content with taming the reflux beast, most folks I know who have GERD would rather beat it to death with a stick.)

First off: the what. The standard explanation for GERD goes like this. When someone suffers from a bout of heartburn, acid in the stomach essentially rises into the esophagus following a spontaneous lapse of the lower esophageal sphincter. Although the stomach lining can inherently withstand the caustic digestive acid, the esophagus has no such protection. The result of the chemical invasion is the characteristic pain and cramping those with reflux experience. Over time, the esophagus can build up scar tissue. In more serious cases, the scarring can narrow the passageway, so to speak, and make swallowing more difficult and painful. Worse than that, prolonged exposure to digestive acid can induce changes in the cells of the esophagus themselves, which can – in relatively rare but increasing instances – result in esophageal cancer, one of the deadliest forms of cancer.

As for the why, the medical community doesn’t point to a specific cause, but the conventional pharmaceutical treatments address “excessive” production of stomach acid. (Yes, do the double take.) The most common drugs used for GERD are H2 blockers and the aforementioned proton pump inhibitors, which block the stomach’s production of acid (just at differing points of the signaling-production-release process). The old style antacids neutralize stomach acid that’s already there. The irony of treating people with GERD by raising the pH of their gastric juices (making it less acidic) is that food doesn’t digest as well, which can be a contributing factor to GERD. Decreasing the acidity of your stomach acid may provide short term relief, but it’s not a long term solution.

Prescription medication usually accompanies practical suggestions like eating small meals, limiting alcohol and avoiding nicotine (which relax the lower esophageal sphincter) and raising the head of your bed to discourage acid from rising too far up your esophagus at night and disrupting sleep. (On a personal note, some of my worst bouts with GERD occurred in the reclined position of an airline seat, so that final bit of advice never worked for me.) GERD sufferers are also advised to steer clear of common “trigger” foods like chocolate, alcohol, mint, citrus, tomatoes, onions, and spicy dishes, and (drum roll, please) fatty foods because they contribute to what’s known as slow stomach emptying, which can make GERD symptoms feel worse.

All this leaves GERD sufferers with few answers and no real solutions unless you count a lifelong pharmaceutical dependency as a solution. This doesn’t even take into account the countless people who take acid reflux medications who actually report a worsening of their symptoms with medication. The response? A higher dose prescription. Never mind that research connects long-term use of these drugs with a higher risk for serious infection and fractures. Keep in mind that the stomach acid’s job is to both digest for absorption of key nutrients and to kill off pathogens.

I know a number of people who’ve felt utterly wrecked by their long-term battles with GERD, many MDA readers included. I’ve heard stories from folks (on medication, yes) who said they would get a bad bout of GERD and be in agony for days unable to eat anything, unable to sleep or even find a comfortable position. When they were finally able to lick the condition, they felt they finally got their lives back.

So, if it’s not excess stomach acid, what the heck is it then? Let me put it this way. It’s not about excess stomach acid (unless there’s some other kind of underlying and unusual medical problem). The acid itself is a red herring. It’s ultimately the weakened esophageal sphincter itself. While some things like alcohol and nicotine genuinely relax the sphincter, most of the other maligned food categories are simply irritants to an already irritated stomach and esophagus.

Am I going to tell you going low carb is the answer? Partly, yes. There’s been scant research done in this area (as is generally the case with low carb eating). One small study highlights the effectiveness of eating low carb, but the connection has been noted for years in the low-carb community (check out some of the reader success stories) – but without clear rationale. Sure, obesity is a clear culprit, and a low-carb diet will undoubtedly address that condition. Yes, there’s the potent anti-inflammatory power of a low-carb diet. We’ve always known there’s more to the story, however.

Although the research will continue to hone in on the exact mechanism, one microbiologist expert presents a compelling explanation. Dr. Michael R. Eades has written in the past about researcher, Norm Robillard, and his book Heartburn Cured. Like Dr. Eades, I believe Robillard’s theory provides the most sound explanation for the growing incidence of GERD in Western society. If you have GERD, I’d encourage you to read the entire book, but the gist is this. When we eat a high carbohydrate diet, our digestive systems can become overloaded with their breakdown. (Remember, of course, that our systems aren’t evolutionarily designed to consistently handle the common 250-350 grams of carbs per day). The malabsorption of carbohydrates in the small intestine (the seat of many digestive ills) can result in a damaging overgrowth of bacteria. As anyone who’s suffered from digestive bloating knows, gas is created in the process and can be excessive when something is awry. According to Robillard’s theory, the gas “pressurizes the upper digestive system,” which sets in motion the reflux mechanism. Robillard, a long-term GERD sufferer himself, reports being fully cured by adopting a low glycemic diet.

But there’s more. Many people who are diagnosed (and pharmaceutically treated for GERD) can trace to a variety of medications that take a major toll on the stomach. NSAIDs constitute one. (Do you know those people – often chronic trainers – who down Costco size bottles of Advil in the course of a few weeks just to keep doing what they do? Add to this list oral antibiotics, which dermatologists often prescribe for long-term use in cases of acne. Others? Try nitrates, calcium channel blockers, theophylline, and one more of note….

You won’t hear this one from many people, but it’s important. Higher estrogen levels can relax the lower esophageal sphincter and can irritate the stomach and even cause the GERD or GERD-like symptoms (which – as in many cases in general – may be more simple stomach irritation than actual reflux). Most women who’ve been pregnant experienced heartburn in their later months. Sure, a growing fetus and all its supportive baggage (e.g. amniotic fluid and the like) pushing up on all of your organs can impact digestion, but rising estrogen has a hand in this as well.

Pregnant women usually have the baby and that’s that. The hormones shift again, and the reflux goes away. But there are millions of women who every day effectively supplement estrogen with the birth control pill or post-menopausal hormone therapy. For most, the uptick won’t be a major issue. For others, however, this medication may cause significant irritation and inflammation in the stomach as well as encourage GERD by its effect on the esophageal sphincter. In follow up research to the expansive Nurses Health Study, GERD symptoms were more common in those who were taking estrogen hormonal therapy. The larger the dose and longer the use strongly correlated with a rising severity of symptoms. Although the nature of the study didn’t isolate other risk factors, it does begin to illuminate a connection we’ve known for years and should expect now. On an anecdotal and wholly unscientific note, I knew a woman who took Nexium for three years before a nurse practitioner suggested the Pill might be related to her debilitating stomach pain. After going off the Pill (which she’d been on for 10 years), her symptoms finally subsided.

If you experience GERD even on a low-carb diet (and without medications known to negatively impact digestive function), a food allergy (often dairy or grains related) or chronic infection (including H. pylori) might be the culprit. Keep in mind also that for some people, an acid reflux problem can become imbricated (today’s fifty-cent word) with a whole host of other conditions (e.g. a systemic yeast overgrowth or other internal inflammation, etc.) A complete work over might be in order, and an intensive, very low carb period can help starve systemic yeast.

As Melissa from Hunt.Gather.Love. suggests (in relation to her own battle with GERD), it’s important to have patience with the healing process. Once you get rid of the underlying cause(s) of your GERD (and get off the pharmaceuticals), there’s a weak, out of order digestive system to bring back into balance. Commit yourself to a restorative mindset and regimen for a few months.

Here are a few things you can do to support healthy digestion:

Take an HCl or other digestive enzyme supplement for at least a few weeks if not months (if your reflux is bad). I believe Robb Wolf recommends NOW Super Enzymes.

Try old-fashioned bitters (remember those?) with or after each meal which can encourage better digestion.

To contend with lingering symptoms while your system heals, try slippery elm, ginger, or DGL (deglycyrrihizinated form of licorice).

Some people – men and women – have luck with the various morning sickness teas, which contain a combination of stomach soothing and pro-digestive herbs.

Thanks for reading today, everyone. I’d love to hear from folks who have beaten GERD and those who are still working toward a full solution. Share your thoughts and perspectives, and have a great hump day!

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Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

I had minor acid reflux that was getting steadily worse, but a few days after I started low carb, it went away entirely. It returns every so often, but usually is the result of eating too much or going off the reservation.

My pain was horrible for years… I didnt have the money to find out what it was b/c I have no insurance… giving up the grains and going paleo cured it! I have not had a priolosec since starting this way of life and I feel AWESOME every day!

Paradoxically, a friend of mine who suffers from acid reflux has controlled the problem by taking hydrochloric acid capsules while she eats (about 4 spaced out through a meal). Apparently, there is a portion of the medical community that believes the problem is caused by NOT ENOUGH stomach acid. Adding extra acid during meals seems to be working for my friend, so it may be worth checking out.

I will have to agree. I think it’s the lack of acid, especially after eating a bigger meal(with procesed carbs) when people have the problem.
My husband and I have great luck with
Apple Cider Vinegar. If you mix a tbls. with a couple of ounces of warm water, it’s really not bad. It will also help to balance your Ph levels amoung many other benefits:)

Just sprinkle some powdered stevia in the apple cider vinegar/water and presto- apple cider.
tastes great, no calories or sugar.

benji wrote on September 10th, 2011

Please let me know when did you use ACV, while taking food or after having food.
Thanks for your all help
Manny

M Manny wrote on February 4th, 2015

Nicky i agree with you 100%, i have used HCL in the past and it made a difference, also helping with the digestion of protein.
Most people dont realize that GERD is nothing but the body’s signal of saying “what the heck are you giving me to convert to fuel” also it says, “i will not digest it and in return you will get the message”, lol some people still dont get that and live on meds for that same reason. Just listen to what the body is saying!

Mark- one thing to be aware of when you do drop the PPIs- the sudden drop off of meds will cause your stomach to go into acid production overdrive, and will hurt like crazy. After going primal, I stopped taking Prilosec, and my heartburn lasted about three weeks with pure pain- almost to the point of giving in and taking them again. But, one morning I woke up and the pain was gone. Haven’t touched the meds in a year and a half. Like you said and Melissa and I have talked about, patience is key! Good luck!

Oh man, this is so good to hear. I’ve been on PPI’s for the better part of the past 6 years, and just quit taking Prevacid. It’s been two weeks and I was about to give up. I don’t have reflux, just a constant burning. I’m so glad to hear that it gets better!

I too took prilosec for years and then quit cold turkey. The pain was horrendous and I almost started taking them again, but I stuck it out. Now I am 100% heartburn free, unless I eat something with wheat in it, which is very rare.

WOW !! Im glad that did not happen to me; I was on them for around 5 years…. and I quit cold turkey and was FINE immediately! Totally pain free every since giving up grains and going Paleo!

Karen wrote on September 17th, 2011

From what I’ve read, there’s a terrible rebound effect if the PPI’s are stopped suddenly rather than a gradual weaning off of them. Glad you were able to stick it out until that was no longer the case for you.

Nothing like Big Pharma making sure we stay hooked once we start on a med —-

You could try the homeopathic remedy Carbo vegetabilis (30C potency) when decreasing your medication – it also can be used by anyone who is suffering from reflux (or from over-indulging)

From Nature’s Materia Medica by Robin Murphy, ND, Carbo vegetabilis – section on stomach – “burning in stomach, epigastric region is very sensitive; digestion slow, food putrefies before it digests; distress comes on a half-hour after eating; belchings after eating and drinking, temporary relief from belching. HEARTBURN. pain worse lying down.” You can have one or more of these symptoms.

You can take 2 or 3 pellets (let them melt in your mouth) to relieve symptoms and can repeat the dose several times

Anyone have a perspective on infant GERD? Our little one was diagnosed with silent reflux (no major structural abnormalities) around 2 months and put on Zantac, which made a world of difference. 2 years later, he’s on a proton pump inhibitor, and I’m wondering if he’s ever going to go off meds!

No, no allergy testing. When I was exclusively breastfeeding him, I did a month without dairy, a month without gluten, and both months without tomatoes, strawberries, peanuts or soy. Didn’t make any difference. Is that something to pursue, you think?

Rachel, I know infants can be prone to this. (Our daughter had it for the first year but never enough that we considered medication. I just cut down on allergenic foods and co-slept to help her if she woke up with problems.) Because reflux issues can take so long to resolve themselves even after a trigger is taken away, I’d go for it and make a plan to get your child off the meds very gradually over time regardless. At 2-years-old, his digestive system has matured, and the flap (sphincter) should be less relaxed. (That’s what our pediatrician told us — 1 year of maturing resolves it for most kids.)

Jen wrote on September 7th, 2011

A month without gluten or dairy is not enough to clean out your system. For dairy it’s at least 6 weeks, I think it’s 2 months for gluten. Have you thought of GAPS?? gapsdiet.com

Magda wrote on September 7th, 2011

I found that I get GERD with gluten, dairy, corn and rice. Aloe Vera juice and capsules, l-glutamine caps, Throat Coat tea, apple cider vinegar, acidophilus, and Antisid wafers (got at Whole Foods, they are kind of like a natural Tums) all helped heal the lining of my gut.

Vanessa wrote on September 8th, 2011

Vanessa, I tried probiotics and acidophilus for YEARS without the slightest result. The truth is that while the bacteria in these concoctions is harmless to us they don’t make it into our guts alive. Certainly did nothing for the horrible stomach pain that was being caused by eating things I was allergic to.

I do think there is a lot of sense to taking betain HCl and papain, or even apple cider vinegar, if you have lowered your acid production after years of proton pump inhibitors. At the least you will send the helicobacter, which cause so much pain, into temporary hiding. At best you will be able to absorb more nutrients.

Another Halocene Human wrote on September 10th, 2011

How you consulted with anyone regarding feeding therapy (an occupational therapist or a speech-language pathologist)?

I’m a speech-language pathologist, however I’m afraid my expertise is limited in the area of infant dysphagia (speech therapy is a VERY broad field). There are professionals who specialize in that area though.

Melissa, I would second GAPS Diet, most definitely. The doctor who wrote the diet recommends giving babies a pinch of HCL Betaine (brand is NuTriVene) to help stimulate stomach acid. You will notice a difference within one dose. Fruit is acidic, so that’s probably why he won’t eat it. Look into doing the muscle allergy tests – they are more accurate since he is still pretty young for other allergy tests to be accurate. But the GAPS Diet will heal the intolerances if that is the case… Good luck!

I have a son who was diagnosed with Eosinophilic Esophagitis. This might be something to look into. The Pediatric Gastroenterologist put him on Omeprozole and we have been battling for 4 years to get him off. It is terrible to watch your child in pain. Get him off the pharmaceuticas as soon as you can. I feel like every day we are sliding deeper into trouble. We have gone thru all the allergy testing and gone grain, dairy, and legume free for a year we are definately Low carb and have dabbled with GAPS, but he won’t eat fermented foods so I give him good probiotics.

My son has Esinophilic Esophagitis as well. And, I’ve been trying to force him to eat Primal because I know it will help. (My horrible reflux completely stopped on 7/27 when I started primal diet.) We did all the allergy testing and nothing came of that. He was on Budesnide (sp?) 1x a day and Nexium 1x a day as well. Then his next scope showed his EE went from 27 per inch to over 100. So, they doubled both meds to 2x per day and added Singular. His last scope showed he was cured. Although I’m afraid it will come back since we are now off meds and haven’t changed his diet. (He’s 15 and I keep trying to get him to go primal – but it’s not working.) I had never heard of EE before this diagnosis. I kept thinking about the entire time I read Primal Blueprint…and drawing connections between our huge consumption of grains in this country and all sorts of “new” ills. Hope your son gets better asap. Thought I’d share our medicine story in case it might help. Take Care.

I know this is a little late but in case others stumble upon this, I am 24 and diagnosed with EE. I have been eating strict primal for about 5 months now and there honestly hasn’t been a difference. I understand that primal is the healthiest of livestyles, I have lost weight and gained muscles since beginning the lifestyle but it is not the solution for every EE sufferer. It has to do with allergies of specific foods not just grains or carbs. Sadly I feel mine is mostly meats (haven’t been officially tested because I wanted to try the primal lifestyle for awhile.) So if your son is having issues and complaining even if he did switch over then please listen to him. I’m gonna stick with primal even though it hurts me. I dealt with the issue for about 4 years before even going to see a doctor so I just deal with the pain. Some times I get really bad episodes but I’m not willing to eat lethal grains where EE is just a pain causing issue. Hope this helps some.

Bobby wrote on April 3rd, 2012

…and bear in mind that PPIs (prilosec, prevacid, etc) are the perfect drug from a pharmaceutical profit perspective. studies have shown that severe rebound effects can occur when stopping these meds or missing doses (even in people without GERD that start them). this of course re-enforces the patients’ perspective that they are helpful. as a pharmacist, i see this quite frequently. the only solution is a slow taper off and making friends with potentially several weeks of increased symptoms.

I suffered from heartburn for years. I would take 24 hour “acid reducers” every day just to feel normal. My symptoms would be worse when I was hungry, so the CW of eating less and avoiding certain foods didn’t apply to me. I felt like I had a serious medical problem and even underwent a endoscopy (and biopsy) to check for scar tissue/cancer in my esophagus. (The results were negative.)

It wasn’t until after I lost weight by low-carb dieting that I realized I didn’t get heartburn any more. I didn’t know if it was from losing weight, or cutting out grains. But now, if I eat grains, heartburn is almost guaranteed to return for a brief period of time, so I attribute my heartburn mostly to a food allergy.

It’s good to know I’m not the only one who has found relief by going primal.

Mark missed a big one in this article by not discussing the causes of a weak esophagal valve. Acid reflux can be a symptom of a hiatial hernia, which is–guess what–associated with sitting and with straining to defecate, especially from a high seated position, rather than (primally) squatting.

I’m shocked that he missed a chance to hammer the message home about primal movements and posture.

I think acid reflux is multifactoral but this piece of it should not be dismissed.

Thank you for mentioning a hiatal hernia!! I’ve recently been diagnosed with a hiatal hernia (it’s pretty large for my small frame). I had a severe bout of the stomach virus and shortly after, I could barely swallow. What is the solution if you have a hernia? I rarely, with the exception of this instance, see this mentioned? How are all the comments and diet advice going to help if your stomach protrudes into your esophagus? I eat very healthy and am underweight and unfortunately on meds since I could not eat or swallow anything. Is there any hope for those of us with a hernia? Thanks!

I used to get absolutely terrible acid reflux. I haven’t had reflux since eliminating grains (12+months), limiting carbs and upping saturated fat (and I drink a heroic dose of coffee every day, and eat very spicy food).

My doc told me to avoid tomatoes and spicy foods. I knew hot peppers didn’t cause the reflux, although they could make it more painful, and I didn’t care to give up tomatoes. Well, one day the pain got so, so bad that I decided to get a (horrors) sauce-less pizza–and my reflux was worse than ever.

That was the day I started to suspect that the wheat might have something to do with it.

Heck, a few days after that revelation and the start of my crash elimination diet I actually deliberately overate fish and chips (fish was coated in cornmeal instead of flour)–and kept it all down!!! Overeating? HA! My esophagal valve is STRONG.

Heart burn is the reason I started researching my diet in the first place. That research ultimately led to me finding out about the paleo/primal diet and lifestyle.

When I first developed the heartburn, I turned to my doctor for advice. He put me on some pills (PPI) which I threw away before taking. I don’t like to take medicine. Not even for a cold or fever.

So I began researching ways to cure the heartburn. I came upon something called organic apple cider vinegar. If I took a tablespoon of it with every meal, I could eat whatever I wanted and never have heartburn or indigestion again. Everything was perfect.

However, I didn’t like the idea of swallowing acid all the time. I was looking out for my teeth and vocal chords.

So I delved further into the realm of the paleosphere and found out all about gluten, casein, legumes, etc.

So – I cold turkey quit all dairy, grains, etc. Ever since that day I haven’t had one day of any indigestion or pain or heartburn. I’ve since found out a whole bunch of factors that can help you get away with eating a bad diet, like lots of natural vitamin D, lots of fish oil, taking the ACV, etc, but the main factor seems to be keeping the diet full of good nutritious non irritant foods.

Maybe I am preaching to the choir here, but hopefully someone will see this and not go through what I went through. Take my knowledge and cure yourself.

I discovered ACV because I was looking for something to help with energy since I’m not keen on medicine/pills either. While researching it, I discovered it would help with heartburn which my husband suffered from terribly. Once he started with ACV it cleared up. There were times he was without it and took a packet of plain yellow mustard or some other vinegar and that worked as well.

Now that we’re Primal and low to moderate carb, there isn’t a need for the ACV, but I still like to use it in salad dressings and the like.

Yup, I still use it here and there, just not to the extent I did before I went primal. I’m not exactly sure how it worked so well though. I mean, while I was on ACV, I was eating everything that is bad for you, with no problem. I’m guessing it just denatures the proteins even more than your stomach acid does, and renders them harmless. That’s just based on conjecture though.

oh, this is the worst. before taking control of my diet, back in the SAD years, i can remember horrible, sleepless, painful nights… thankfully, this is gone. primal diet seems to keep it gone too, but i will say, that in my low-fat mostly plan-based years, it was also in check. perhaps the real culprit is processed foods?

Currently 31 weeks pregnant with twins and when I “fall off the primal wagon” it is miserable!! If I watch my diet pretty closely I’m usually fine. Occasionally I’ll have a bout I can’t explain but I just blame it on one if the girls being in a position that puts more pressure on my stomach

I have had GERD for many years. So bad that it caused damage to the vagus nerve which resulted in gastroparesis (slow stomach emptying). I had great hopes that cutting out grains and eating low carb would help, but alas I still must take Zantac and Erythromycin just to make it through the day. At least I got off the PPIs which were causing terrible stomach pain. I have tried to go off the meds but it just does not work because of the physical damage done. I did go off them recently due to being pregnant and the symptoms were awful. Then I got the OK to go back on them and things seem to be ok for me and baby to be. I will never eat grains again as even thinking about or smelling them makes the acid rise. I enjoy the primal diet and lifestyle but in my case it has not helped the GERD.

Really? I am 21 and have severe gastroparesis since age 16 as well as GERD since age 4. I also have impairment of small intestine and SBBO. Are you able to follow a primal diet pretty well? I cannot digest meat and am allergic to eggs. And yes, I have tried every digestive enzyme on the market.

I come from a long line of folks with gastroparesis so it was pretty much a given that I would get it. I am also allergic to eggs, soy, and gluten. I can do the primal diet easily, meats are OK as long as I don’t eat too late at night or too much at one sitting (6 oz seems to be the meat limit for me). If I eat any more than that then I end up taking another Erythromycin to get things moving in the stomach and gut. Dairy doesn’t bother me so I do eat Greek (Fage total) yogurt and cottage cheese. I did go for over a year without any dairy at all with no change in symptoms so I decided to add it back in since breakfast is limited without eggs. I eat lots of veggies and fruit in moderation too.

One of the great fallacies of this syndrome is that the esophageal sphincter is weak. In some cases that can be. But the most instances, it is that the duodenal sphincter (the other gate) that is stronger. It’s purpose is to restrict the stomach contents (chyme) until the pH has been lowered to a point where the more sensitive upper GI tract can do its job without being damaged (digested, as in duodenal ulcers) by your own gastric solutions. There are several reasons your stomach wont let go – but the bottom line is your system is electing to expel the harmful stuff rather than have you digest your own bowels from the inside out. Sorry if it sounds gross, but if it rings a bell, look into it.

Not to worry, not gross, by any means. Nothing biological can be gross. However, if this theory is correct it means the system is actually choosing to expel acid from the other end, i.e. oesophagal sphincter, which doesn’t sound logical. I presume it makes nodiff whether the acid goes into the duodenum or the gullet, both are equally bad. Why, then, should the body choose to protect itself from harm at one end of the stomach by causing harm at the other end? Any research available into either theory that you’re aware of?

K.Gopal Rao wrote on September 9th, 2011

My reflux went away completely within 3 days of going Primal and cutting out grains.

Now, the only thing that upsets me is if I have too much dark chocolate. If I stick to 2 squares I’m ok.

I never (well, rarely) had indigestion or an stomach ache before starting the Primal diet. Now I have it all the time! I feel miserable! I have been on the diet now for 2 weeks! Am I doing something wrong? Is this a normal reaction?

You probably want to take this over to the Forum Kathy. There’ll likely be plenty of advise there.

It would be helpful if you mention some specifics about what you now eat and how it’s changed for you. Are you eating much more meat? More dairy? That kind of thing.

Generally the reverse effect is found. I’d take a wild guess that you may have less stomach acid than you need – which is easily correctable (Google HCL and Betaine) – and well worth doing to get the full value from your food

Thank you so much for covering this subject Mark! I’ve been meaning to email you about it since my Mother suffers from GERD and it has been a major obstacle in getting her to start Primal since she attributes her heartburn to eating meat. I really don’t think that is the case at all since it doesn’t happen every time she eats meat. I think her digestive system is in serious trouble based on a combination of symptoms.

I lived with daily, terribly painful GERD symptoms from my early 20s until recently. I popped Maalox, Tums, PPIs, baking soda and more multiple times every day. I even ended up in the ER one night as the GERD was so bad that I didn’t recognize it as GERD. I though I might be having a heart attack. The doctor gave me the usual advice that you noted in your article. Nothing helped.

About 2 weeks after going low carb (9 months ago,) I noticed that I no longer needed the medications. I’ve been GERD free since then, and am so grateful. I do think that grains most certainly were a big culprit. I will never eat them again for a variety of reasons, that being one.

I used to have the most horrible episodes of GERD. Some nights, in my sleep, acid would rise suddenly and explosively to the point where the acid would pour out of my nose and I would aspirate it into my lungs. The burning was horrendous and I would cough for hours trying to get it out of my lungs.

Within a couple of weeks of going Paleo and cutting out all the grains, I stopped taking the two Prilosecs a day and have never looked back. My doctor is intrigued to say the least!

Glad to hear you have improved. It’s really wretched, isn’t it? I Had the same experience long before I went primal, for about a year, even though I’m real healthy with no problems. I was determined to stay away from the witch doctors and their pills. Started some research. Drinking lots of water (Your Body’s Many Cries for Water) helped tremendously, but I still had frequent episodes. I even started having swallowing trouble at some meals, so this was not a good sign. Started taking notes. My worst episodes were starchy meals, especially with dairy. Pizza (one of my former favorites) was the worst, especially bad when any meal was followed by ice cream for dessert. I gave up dairy 4 years ago because of my sinus trouble, and it transformed my life in several ways. The GERD stopped in it’s tracks. A few marginal episodes, only 3 bad ones in 4 years. But why any? The grains were the last piece of the puzzle. Swallowing trouble still occurred, though diminished – starchy meals (with rice and pasta) and lunches (sub sandwiches with big fluffy rolls) were notable. My body was literally trying to reject what I was eating. Switching to flat breads helped some. Then I started taking Primal seriously. My wife loves hot dogs and hamburgers so we had them for dinner a couple times a month. I noticed every time that my dinner would sit on my stomach like lead all night, a rare experience those days. I had been reducing grains by experiment and this was one of my few last hurdles, so I tried alternating the same meal content, but minus the buns. Viola. Felt great with no bread, crappy with it. This was the final straw for my grain-free commitment.
Those damn commercials drive me nuts. “Everytime I eat (whatever) I get awful heartburn!” Why are you eating it? Are we completely crazy these days? We blame everything but the real cause – it’s not the spices, or the garlic, or the tomatoes, or the meat, etc. Cultures have eaten highly spiced food for millenia and their digestion is HEALTHIER because of it. The spices are terrible irritants when they get expelled, but not the cause. I know alot of Primal enthusiasts eat dairy, fine if you have no problems, but I highly recommend trying to give it up if you have any of the typical problems – especially respiratory. I was a terrible snorer too – my wife was afraid I was getting sleeep apnea. That stopped on a dime as well. I can’t help but wonder how may people are sleeping with those horrid pressurized breathing masks whose only real problem is cheese.
BTW – I hope your doctor IS intrigued. Mine was really interested as soon as I mentioned GERD, but he turned off immediately when I said I was doing alot better with water and behavior modification. On to the next check box – maybe there’s some other drug he can foist on me. I fear few doctors want to really hear these things. Their business has become dispensing chemicals, not helping you to heal.
Hope you continue to do well.

Now that I eat primal I only drink water when I’ve been sweating outside. I’ve switched from watered-down gas station coffee to espresso and get annoyed at all the liquid in tea (I have to pee again?!). Rare juice or alcohol, replaced milk with cream, butter, aged cheese, yogurt, sour cream.

According to some doctor’s blog (that was linked in a primal blogroll), too much water at meals increases stomach pH and kinda sabotages good digestion. I have found this to be sound.

I recall the first time I experienced the reflux and the time that it awakened me in the middle of the night. It is so awful. I was just telling my son about the fact that I never have it any longer and described my primal diet to him.
He said I lost him when I talked about giving up grains. That was this weekend! And, today’s post was copied and sent to him. I surely hope he reads it.
Thanks for a great article and to PB.
Pam

What about a hiatial hernia?? A low carb diet drastically helps but I still have issues. My doctor critisized my stubborness of taking ppi’s & made it sound like my GERD may not be able to be treated naturally due to this hernia. . Do you think that is true? Everyday my esophogus is getting more irritated and as a result am engaging in this mental battle of whether or not to medicate.

I was told all my GERD was related to my large hiatial hernia. I had to sleep with the head of my bed raised. Funny thing is that when I started a very strict gluten free diet, all my GERD disappeared. Can’t even have a crumb of gluten. That was 8 years ago. Went paleo about 2 yrs ago and still doing great.

If I understand right, a Hiatal Hernia is when the stomach is pushed up through the diaphragm and all or part of it is in the chest cavity, where the heart and lungs are supposed to be. If that information is correct, my sister’s chiropractor helped her by pushing downward on the area of pressure, til she moved the stomach back down through the diaphragm to where it belonged.

When I felt pressure in my chest and around my lungs with heart burn symptoms I tried pushing down on it and could feel it gurgling and moving and then I felt much better.

I’ve also found that excess salt or carbs with fat is a trigger for me.

NSAIDs can also cause GERD, and a lot of people take them regularly. I used to, and suffered horrible GERD that I mistook at the time for a heart attack. Weaning off excess use of NSAIDs helped me clear up esophogeal pain in days. If your stomach is already irritated, dietary irritants will only exacerbate the issue.

Hear, hear. Had some horrible episodes with NSAIDs (I think they’re also called COX II inhibitors?).

I had to stop taking them entirely for a while, no matter how bad the pain. Now that I’m primal my pain is less intense and less frequent. I think my inflammatory levels are way down. Don’t eat things you’re allergic to!

I had terrible GERD for several years at the same time as many other symptoms, I was gulping acid back down my throat all day and night. Cutting gluten fixed it though I still get a little bit at night even though I am now totally grain free. But it doesn’t affect my quality of life like it used to. The only reason it didn’t seem a huge deal at the time was that gluten made me so sick in other ways too!

I suffered with reflux about 18 months ago, my doctor (although prescribing the usual meds) was actually quite clued up and mentioned a lot of what you’ve mentioned here, Mark. Long story short, she suggested playing around with my diet and eliminating anything that irritated my system. The easy culprit to identify was dairy – I had a lot of cow’s milk products in my diet back then, and my symptoms almost vanished when I cut it out. I like my dairy though, so I swapped to goat’s milk products and found the symptoms lessened further still. But going Primal has made the big difference – my digestive system is now very settled (no reflux, little or no gas, and no bloating), so much so that I have reintroduced cow’s milk products into my diet over the summer (strawberries just aren’t the same without cream and I can’t get cream of the goat variety ANYWHERE… as yet…) So for me it was: less dairy (and more easily digestible dairy when consumed) and less carbs…. wait, that sounds familiar…

I developed GERD this past January and did a lot of research. In addition to Norm Robillard’s fine book, I recommend that people read “Breaking The Vicious Cycle” by Elaine Gottschall, which discusses microbial dysbiosis in greater depth. While she recommends the diet for Crohn’s and Ulcerative Colitis, it works for the dysbiosis Robillard describes in his book.

I was shocked (and pleased!) to discover, Mark, that your dietary recommendations are almost exactly the same as the dietary recommendations in The Specific Carbohydrate Diet (SCD), with only a couple of exceptions. The key isn’t so much to limit carbs, but to limit all but the most SIMPLE monosaccharides, the fructose and glucose found in fruits and vegetables. Damaged small intestines are unable break down more complex sugars (sucrose, starches), and intestinal damage can be assumed with the acidic activity of fermenting microbes. These un-digested sugars become the food for microorganisms, setting up a vicious cycle of injury and microbial overgrowth.

Another great resources is Dr. Siebecker’s blog about SIBO (small intestine bacterial overgrowth).

I was going to mention the info Julia wrote above, about avoid all but monosaccharides. An interesting book is http://www.lowstarchdiet.net/. I am following a strictly low starch paleo diet as I have mild AS, and it has helped my gut with some milder issues that stopping gluten didn’t completely get rid of. If you have any joint issues as well I would definately recommend trying a period of strict low starch and disaccharides.

Perfect timing! i just spent all day yesterday researching this very subject. I’ve been taking Prilosec for 1.5 years. Now that I’ve gone Primal(2 months now, I thought it’s time to get off the med’s. I’m taking HCI/Pepsin with every meal. So far seems to be working. This is a temporary thing as my body adjusts. It’s a slow process but that I think is worth it!!

After having GERD for his entire adulthood my husband was recently diagnosed with cancer of the esophagus. GERD CAUSES CANCER. It is too late for him to save his esophagus, but it is not too late for many of you. This is NOT something you want to mess around with. Those drugs made him virtually asymptomatic, but the damage continued. Hopefully he will survive the cure.

My GERD only rears its head if I am eating things off the paleo/primal grid, such as any grains, definitely baked goods of ANY kind (even though I only eat gluten-free, doesn’t matter), and a lot of sugar.

I’m a physician and have advised patients for years to do “lifestyle measures” like elevating the head of the bed, avoiding fatty/spicy food, alcohol, chocolate, mint, smoking (and then I usually ended up putting them on PPIs when those measures didn’t control their symptoms). But of all the foods that might cause or worsen GERD symptoms it never occurred to me — nor was I trained — that grains could be the problem or at least part of it. I suffered from GERD too and was on PPIs myself, but not anymore: my symptoms disappeared when I went primal and eliminated grains. I know gluten isn’t the answer for everyone, but it made all the difference for me and I encourage anyone with GERD to at least try a 30-day grain-free trial. And yes, people give me that that “are you crazy? Grains are the basis of the food pyramid” look when I suggest this.

Hi
I’ve been eating Paleo for the past 2 months and my stomach discomforts have been getting worse, although a bit different than usual(i.e. feeling more like light acid reflux rather than paralyzing heartburn). I’ve been diagnosed with gastroparesis (type 1 diabetic). What can I do and eat to stay paleo and try to manage my blood glucose levels and my general health? Enzymes? Food combining (fruits seem to make me bloat more than ever)? Reduce fats (these also seem to make it difficult for me) Taking ACV? Any suggestion is welcomed since I don’t know who to ask nor what to expect from my own endocrinologist. Thanks : )

Tell them to try taro root. You can cook it in a minute in the microwave.

Or potatoes. Everyone knows how to eat those. (Not french fries b/c most places they are “dropped” in the same fat with breaded items, meaning they are full of gluten. McD’s fries have their own, segregated Fry-O-Lator, so they’re okay, though certainly not primal with that nasty “vegetable” oil.)

You can buy cassava/yuca in latin supermarkets frozen and boil it. Good with butter or garlic sauce or in meat stews.

And sweet potatoes! Nature’s perfect food. Get them to nyam their yams, butter their batatas, roast their red sweets. I ate so many sweet potatoes when I first went gluten-free I didn’t want to see any more orange food after a while.

Most people have heard that sweet potato is good for them so why not let them try it? There are yellow batatas available in US supermarkets for when you reach your personal carotinoid compound limit. I think I have a higher tolerance now after giving myself WAPF-style Irish butter therapy (plus outdoor time). Up the A, D, K complex and orange is suddenly A-OK. (Are you groaning yet?)

Tom it’s very refreshing to hear a doctor say that they have not only found that the Primal way of eating helped and that they also now advise their patients of the same.

It’s very easy for people to blame doctors for putting them on drugs rather than finding the cause but the information on this is just not commonly known (yet?). So often we hear of doctors casting aspersions on the idea that diet can change such things. Great to hear of a doctor that’s open minded enough to have worked this out properly and acted on it.

I recommend digestive enzymes for a few months along w/ a grain-free diet. For immediate, short-term relief, down a spoonful of organic apple cider vinegar. The taste isn’t great but the relief is amazing.

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